WAG 23-08-04: Identifying and Reporting TPL

Person Who May Have Group Health Insurance

Persons who are working, have recently stopped working, or on a leave of absence.

Dependent children whose parents or stepparents are employed. Absent parents may have dependent insurance coverage through their employment.

Physically or mentally handicapped dependents whose parents or stepparents are employed and continue to provide support.

NOTE: Under the law, health insurance coverage for handicapped dependent children must not terminated solely because they reach a certain age.

College students.

Members of a union, even if not currently working.

Retirees.

Persons Who May Have Individual Health Insurance Policies

Self-employed persons.

Persons who have Medicare. These individuals frequently have Medicare supplementary health insurance policies.

Retirees.

Persons Who May Have CHAMPUS or CHAMPVA

Retired military personnel.

Spouses, children, and dependents of:

active duty Army, Navy, Air Force, Marine, Coast Guard, Commissioned Corps of the Public Health Service and Environmental Services Administration,

retired military service personnel,

deceased retired military personnel.

(FCRC) Review Form 267 TPL and identify all third party resources.

If a TANF applicant or client, or an AABD applicant or client who is applying for or receives TANF for a dependent child, is employed:

(FCRC) Check the "Dependent Health Insurance Coverage Manual" to see if a client has no-cost dependent health insurance available through their employer. The manual lists employers known to HFS that provide their employees
with free dependent health insurance.

NOTE: The manual is provided to the Financial Recovery Coordinator.

Contact the employer by phone or mail to verify that the resource is free and available.

Document the phone conversation.

Tell the client they are required to enroll the dependent(s) who is eligible for this coverage as soon as possible.

Deny or stop medical for adults who do not cooperate (see PM 03-19-00).

NOTE: Do not deny or stop medical if an absent parent refuses to sign up for no-cost dependent health insurance.

(FCRC) Identify TPL during a review of information obtained through a crossmatch.

Enter the 3-digit crossmatch (or ICL code) in Item 8 of Form 1442.

(FCRC) Contact the employer, union or group offering the insurance if the client is not certain whether members are covered by group health insurance. Contact can be made by phone or mail.

(FCRC) Send:

Form 266A, or

Request for Employment Verification - AABD (Form 266-ACF), or

Request for Employment Verification (Form 266CF),

to employers to verify the availability of a TPL resource.

(FCRC) Copy the reverse, Form 266A/1422, when the employer returns Form 266A verifying the availability of a TPL resource.

Send a copy to TPL Section.

If an applicant cannot provide the SSN or the insurance group number for an absent relative who provides group health insurance for assistance unit members:

(FCRC) Contact the employer by phone or mail to obtain the information to complete Form 1442. No consent is required.

Document phone verifications in the case record.

When a TANF case is canceled with extended medical and an employed client has not reported TPL information: